Hypoventilation following oxygen administration associated with alfaxalone–dexmedetomidine–midazolam anesthesia in New Zealand White rabbits

Abstract

ObjectiveTo investigate the relationship between oxygen administration and ventilation in rabbits administered intramuscular alfaxalone–dexmedetomidine–midazolam. Study designProspective, randomized, blinded study. AnimalsA total of 25 New Zealand White rabbits, weighing 3.1–5.9 kg and aged 1 year. MethodsRabbits were anesthetized with intramuscular alfaxalone (4 mg kg–1), dexmedetomidine (0.1 mg kg–1) and midazolam (0.2 mg kg–1) and randomized to wait 5 (n = 8) or 10 (n = 8) minutes between drug injection and oxygen (100%) administration (facemask, 1 L minute–1). A control group (n = 9) was administered medical air 10 minutes after drug injection. Immediately before (PREoxy/air5/10) and 2 minutes after oxygen or medical air (POSToxy/air5/10), respiratory rate (fR), pH, PaCO2, PaO2, bicarbonate and base excess were recorded by an investigator blinded to treatment allocation. Data [median (range)] were analyzed with Wilcoxon, Mann–Whitney U and Kruskal–Wallis tests and p < 0.05 considered significant. ResultsHypoxemia (PaO2 < 88 mmHg, 11.7 kPa) was observed at all PRE times: PREoxy5 [71 (61–81) mmHg, 9.5 (8.1–10.8) kPa], PREoxy10 [58 (36–80) mmHg, 7.7 (4.8–10.7) kPa] and PREair10 [48 (32–64) mmHg, 6.4 (4.3–8.5) kPa]. Hypoxemia persisted when breathing air: POSTair10 [49 (33–66) mmHg, 6.5 (4.4–8.8) kPa]. Oxygen administration corrected hypoxemia but was associated with decreased fR (>70%; p = 0.016, both groups) and hypercapnia (p = 0.016, both groups). Two rabbits (one per oxygen treatment group) were apneic (no thoracic movements for 2.0–2.5 minutes) following oxygen administration. fR was unchanged when breathing air (p = 0.5). PaCO2 was higher when breathing oxygen than air (p < 0.001). Conclusions and clinical relevanceEarly oxygen administration resolved anesthesia-induced hypoxemia; however, fR decreased and PaCO2 increased indicating that hypoxemic respiratory drive is an important contributor to ventilation using the studied drug combination.